home > drugs a-z list > opana er (oxymorphone hydrochloride extended release) drug center > opana er (oxymorphone hydrochloride extended release) drug - overdosage and contraindications

Symptoms

Acute overdosage with OPANA ER (oxymorphone hydrochloride extended release) is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils and sometimes bradycardia and hypotension. In some cases, apnea, circulatory collapse, cardiac arrest and death may occur.

OPANA ER (oxymorphone hydrochloride extended release) may cause miosis, even in total darkness. Pinpoint pupils are a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origin may produce similar findings). Marked mydriasis rather than miosis may be seen with hypoxia in overdose situations [see CLINICAL PHARMACOLOGY].

Treatment

In the treatment of OPANA ER (oxymorphone hydrochloride extended release) overdosage, primary attention should be given to the re-establishment of a patent airway and institution of assisted or controlled ventilation. Supportive measures (including oxygen and vasopressors) should be employed in the management of circulatory shock and pulmonary edema accompanying overdose as indicated. Cardiac arrest or arrhythmias may require cardiac massage or defibrillation.

The opioid antagonist naloxone hydrochloride is a specific antidote against respiratory depression that may result from overdosage or unusual sensitivity to opioids including OPANA ER (oxymorphone hydrochloride extended release) . Nalmefene is an alternative pure opioid antagonist, which may be administered as a specific antidote to respiratory depression resulting from opioid overdose. Since the duration of action of OPANA ER (oxymorphone hydrochloride extended release) may exceed that of the antagonist, keep the patient under continued surveillance and administer repeated doses of the antagonist according to the antagonist labeling as needed to maintain adequate respiration.

In patients receiving OPANA ER (oxymorphone hydrochloride extended release) , opioid antagonists should not be administered in the absence of clinically significant respiratory or circulatory depression. Administer opioid antagonists cautiously to persons who are known, or suspected to be, physically dependent on any opioid agonist including OPANA ER (oxymorphone hydrochloride extended release) . In such cases, an abrupt or complete reversal of opioid effects may precipitate an acute abstinence syndrome. In an individual physically dependent on opioids, administration of the usual dose of the antagonist will precipitate an acute withdrawal syndrome. The severity of the withdrawal syndrome produced will depend on the degree of physical dependence and the dose of the antagonist administered. If respiratory depression is associated with muscular rigidity, administration of a neuromuscular blocking agent may be necessary to facilitate assisted or controlled ventilation. Muscular rigidity may also respond to opioid antagonist therapy.

OPANA ER (oxymorphone hydrochloride extended release) is contraindicated in patients who have:

• significant respiratory depression
• or are suspected of having paralytic ileus
• acute or severe bronchial asthma or hypercarbia
• moderate and severe hepatic impairment [see CLINICAL PHARMACOLOGY, WARNINGS AND PRECAUTIONS,].
• known hypersensitivity to any of its components or the active ingredient, oxymorphone or with known hypersensitivity to morphine analogs such as codeine.

Last reviewed on RxList: 12/28/2011
This monograph has been modified to include the generic and brand name in many instances.